As we get ready, in 2010, to celebrate the 50th anniversary of hormonal contraception in the United States, women have every right to stand up and cheer for a birth control option that has revolutionized how effective a contraceptive can be. “The Pill” and its descendants have indeed provided women with a unique tool that has changed the terms in which women control their social and professional choices.

Amidst all the applause, though, let us not oversimplify the history of a drug that has often coupled danger with opportunity, and indeed reinforced some serious inequities even as it promised to enhance women’s rights. Today, 50 years later, ovulation suppression through hormonal drugs still harbors many adverse effects, which range from mood swings and diminished libido, to fatalities from blood clots. The innovation itself emerged at the cost of experimentation on poor women, and came, in part, out of a desire to control the fertility of poor populations.

The pill was able to be born because of deep social and economic injustices, not solely as a response to them. The pill trials were conducted on poor women in Puerto Rico, in part because they had fewer legal protections against some of the dangers of new drug trials. Male doctors scoffed when female doctor Edris Rice-Wray suggested that the side effects of the new pill might be too numerous to be generally tolerable and carried on with hardly a pause when more than one woman in the trial died mysteriously. It turned out that Rice-Wray was right about the risks of the pill but wrong about women’s willingness to endure them.

It might be easy to see the approval acceptance of hormonal contraception as a pure female victory, and indeed it happened in part because women deeply hungered for reliable birth control. It is also true that it was moved forward not only to satisfy this need, but because of deep anxieties among the powerful that a booming population in the developing world would lead to the spread of communism, and that a similar growth in poor (and non-white) populations within the United States would cause domestic instability. Even as the pill offered the promise of liberation to affluent women it provided a powerful and easily abused tool for controlling the fertility of poor and disempowered women. Margaret Sanger realized this, and readily voiced deeply racist and classist sentiments in service of her otherwise valiant agenda.

Within just a few years of the approval of Enovid, the first pill, it became clear that women were experiencing serious adverse health effects. Barbara Seaman, a young journalist for Brides and Ladies Home Journal magazines realized how common truly frightening health problems were when she began receiving letters from readers. Experiences ranged from the aggravating —weight gain, mood swings, sexual problems—to the life threatening—blood clots and other potentially fatal problems including cancers. Seaman’s ground-breaking 1969 book, The Doctors’ Case Against the Pill, chronicled the suffering of real women on the pill and documented the multiple health risks tying the silence and lack of information about them to drug company greed, unequal power between doctors and patients, and sexism in American life.

(Photo: Planned Parenthood)

It was a tough message for many women to hear, and certainly one that defied (and continues to defy) a narrative that argues simply that access to reliable birth control gives women power. But for those who were willing to take up the difficult implications of Seaman’s work, an important feminist model emerged. When members of DC Women’s Liberation disrupted hearings on the pill spearheaded by Senator Gaylord Nelson it was to protest the manipulative way the pill was being marketed to women, not to praise the product. Women were demanding something truly radical: the right to insist not just on access to contraception, but to demand that the products be safe. Today, while many valid questions about the pill’s safety and side effects remain, the hormone dose has been reduced ten times, and patient package inserts have been added to warn patients of the risks. This is due to the tireless efforts of the women’s health movement.

Women have certainly seen their lives and opportunities transformed in the past fifty years. While the pill is one powerful player in this remarkable story, this revolution has occurred largely through the persistent efforts of women (in multiple contexts and conditions) on their own behalves. The pill did not create second wave feminism. And likewise, it did not create all the changes that that remarkable movement oversaw. Those things happened because courageous women were willing to sacrifice and fight over time for them. In recent years, the reproductive justice movement, powerfully led in many cases by feminists of color, has made the point that single-mindedly striving for the right to birth control and abortion ignores the complex power systems that too often dictate the terms in which women make decisions about their health in general and their reproductive and sexual health in particular.

And that brings us to the current moment. As the pill starts its second half-century, women find themselves dealing with many of the same old problems. Access to health care is deeply unequal: many go uninsured and many more lack basic education about their bodies and sexual health. While the shocking sterilization abuses of poor women and women of color that persisted into the nineteen eighties have been curtailed, the experience of Norplant in the nineteen nineties showed that new and potentially dangerous products are still marketed disproportionately to these women.

Doctors still pressure women to use pharmaceutical birth control and dismiss concerns about side effects and dangers revealing that while women have entered the medical profession, they have not been immune to perpetuating sexism and perhaps even more distressingly, drug company agendas.

Women have come to accept with little question that contraception should be their responsibility. Even in an age when HIV/AIDS has brought new relevance to condom use, women still struggle with partners who insist that it is better for them to bear the costs of contraception in their veins than cause sexual inconvenience. And of course all these years later there is still no “pill for men” or modern contraceptive equivalent for male bodies.

In fact there has been very little contraceptive innovation at all. Drug companies, burned by law suits with the pill, Dalkon Shield IUD and more recent devices such as Norplant have largely decided that the pill (and other hormonal contraceptives) are “good enough.” Repackaging of the same old drugs—in the form of implants, injections, rings, patches and chewables —are sold as innovation and pills promising to eliminate periods show the way in which contraceptives are being subtly re-branded as lifestyle drugs.

Rarely in any contraceptive debate is the issue of respecting a woman’s natural reproductive cycle raised. If men were asked to take a hormonal therapy that would cut off the healthy production of their sex cells, would they take it? Would they take it if it would reduce their sexual appetite and adversely affected their moods? Would they take it if it increased their risks of developing high blood pressure, metabolic problems, certain cancers and having a stroke? Maybe. Yet, women everyday take on these risks to suppress ovulation without ever considering whether they are loosing something essential when they do so.

The pill has indeed helped women to write heroic chapters in their histories. It has provided a contraceptive efficacy that was only a dream before, and other health benefits such as some protection against ovarian cancer and relief for women with severe menstrual distress. But it is not a silver bullet.

And even today it poses serious health questions and comes with a host of side effects. As we stand on this important anniversary, perhaps we need to do the thing that seems to be the hardest: to appreciate this remarkable innovation while also being honest about its limitations. To give credit to this exceptional tool while also frankly acknowledging the sometimes difficult histories that have allowed to it take its current position of prominence in the contraceptive landscape. We need, once again, to broaden the conversation, educating women to make responsible decisions about birth control that would respect other birth control choices. And even as we enjoy and use this amazing product, we need to keep pushing and fighting for something better.

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